title: Stroke at high altitude diagnosed in the field using portable ultrasound.
abstract: A tool that can differentiate ischemic stroke from other neurological conditions (eg, hemorrhagic stroke, high-altitude cerebral edema) in the field could enable more rapid thrombolysis when appropriate. The resources (eg, an MRI or CT scanner) to investigate stroke at high altitude may be limited, and hence a portable tool would be of benefit. Such a tool may also be of benefit in emergency departments when CT scanning is not available. We report a case of a 49-year-old man who, while climbing at 5900 m, suffered a left middle cerebral infarct. The clinical diagnosis was supported using 2D Power Doppler. The patient received aspirin and continuous transcranial Doppler was used for its potential therapeutic effects for 12 hours. The patient was then evacuated to a hospital in Kathmandu over the next 48 hours. This case report suggests that portable ultrasound could be used in the prehospital arena to enable early diagnosis of thrombotic stroke.
authors.affiliation: Institute for Human Health and Performance, Ground Floor, Charterhouse Building, UCL Archway Campus, Highgate Hill, Archway, London, UK. mark@medicstravel.com
authors.forename: Mark H
authors.initials: MH
authors.lastname: Wilson
authors.forename: Denny Z
authors.initials: DZ
authors.lastname: Levett
authors.forename: Sundeep
authors.initials: S
authors.lastname: Dhillon
authors.forename: Kay
authors.initials: K
authors.lastname: Mitchell
authors.forename: Jon
authors.initials: J
authors.lastname: Morgan
authors.forename: Michael P W
authors.initials: MP
authors.lastname: Grocott
authors.forename: Chris
authors.initials: C
authors.lastname: Imray
mesh_terms: D000531:Altitude; D000532:Altitude Sickness / Q000175:diagnosis / Q000000981:diagnostic imaging; D001929:Brain Edema / Q000175:diagnosis / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D008875:Middle Aged; D009051:Mountaineering; D020521:Stroke / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy; D015912:Thrombolytic Therapy; D013997:Time Factors; D017585:Ultrasonography, Doppler, Transcranial / Q000295:instrumentation* / Q000379:methods